Common Medical Billing Claims Rejections Reasons

Do you know your claims denial rate? Some of the most recent benchmarking data for family practice groups suggests averages up 10%, while the AMA found that Medicare rejects roughly 5% of claims. Denied claims leave cash on the table that can impact your profit margin significantly if they aren’t managed properly.

If your rejections are out of control, take a look at these common culprits that lead to denials.

Timing Issues

Timing is everything when it comes to medical billing. Are you watching for these important dates when you file your claims?

Filing after the claims deadline (usually 60 to 90 days).

Do you confirm submitted claims are actually received by the payer within 2-3 days?

Using an expired authorization or referral, or providing services before the authorization was approved. Check dates carefully; some authorizations expire in as little as 30 days. It’s also important to make sure you haven’t exceeded the number of authorized visits or services to avoid denials.

Registration Issues

Your front desk is the front line in successful medical billing, so make sure your staff isn’t making these avoidable errors:

Failing to verify coverage/enrollment status before services are rendered.

Not updating insurance information in the EHR so claims are sent to the correct carrier and address.

Coding Issues

This is one of the stickiest areas for inexperienced billing departments; coding and documentation requirements can vary significantly and lead to delays, rejections, and requests for additional information, slowing up reimbursement. Watch these trouble spots:

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